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86 Cards in this Set
- Front
- Back
Is preggers experience variable between women??
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Pregnancy experience is highly variable and multiply determined according to age, health, resources, occupational status, social support availability, birth history, & whether pregnancy is planned or desired.
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what are common concerns in normal preggers
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Management/meaning of physical complaints
Changes in work and other activities Change in appearance Change in relationships Labor/delivery and baby’s health Shift in identity begins |
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what are psychological reactions to normal preggers
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Lack of scientifically rigorous research
Most women adapt well to pregnancy-related changes Most women experience normal & stable affect across 9 month period Small number of women experience labile affect, but no consistent pattern has emerged (marked fluctuations, gradual changes) Virtually no research on positive emotional states in pregnancy |
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how do women who love every min of being preggers feel and look
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their skin glows, they have boundless energy, they feel more beautiful and sexual than ever
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what if they think they are on the struggle bus?
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moning sickness that occurs morning , noon, and night
Backaches Stretch marks Fatigue Sleep difficulties Along with physical challenges there are emotional challenges… |
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what is the pregger exp in the first trimester
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Conspiracy of Silence
Loss of Separateness Loss of Control Hormones and Mood Parenting pregnant |
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what is the pregger exp in the 2nd trimester
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Differing Experiences for Partners
Sex in Pregnancy Losing Control of One’s Shape “How Can I do This to Number One?” |
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how is the pregger exp in the 3rd trimester
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“When will this be over?”
Letting go and accepting help Birthing Plans Are complaints normal or something serious? |
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how does the women feel on the big day
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Bonding
First Feelings Breastfeeding Pressure Baby Blues The Birth Not Planned |
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how does a women feel in the 4th trimester
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Infant & Mother remain One
Breastfeeding Challenges Seeking Support Accepting Support Nurturing the Nurturer |
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what are the psychological stages of pregnancy: stage one
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Learning of pregnancy-Ultrasound
Physical sxs Memory impairments Ambivalence Fear of miscarriage Stage 1 Task: Acceptance |
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what are the psychological stages of pregnancy: stage two
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Ultrasound-point of viability
Sharing news Time of relative peace and fulfillment Realization that life exists within Stage 2 Task: Recognition of fetus as separate from self |
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what are the psychological stages of pregnancy: stage three
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Point of viability-birth
Physical sxs “Nesting behavior” Fear about birth process & baby’s health Stage 3 Task: Attachment |
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what are common reactions to bed rest/hospitalization
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Heightened concern about one’s own health and health of fetus
Feelings of uncertainty & lack of control Feeling like a “prisoner” Feelings of “missing out” Concern regarding care for other children in family Role reversal with partner Financial stress related to stopping work Separation from usual support of spouse and family (in case of hospitalization) |
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what king of patients requure psych consult
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New psychiatric illness while pregnant
Discovery of pregnancy while taking psychotropic medications History of psychiatric illness with plans to become pregnant History of psychiatric illness who is pregnant |
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give me some facts about psych disorders in preggers
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Arise between age 18-45
Little known about effect of pregnancy on pre-existing illness For those with a psychiatric history, pregnancy is not a time of emotional stability Affect mom’s wellbeing and pregnancy outcomes |
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Mild-moderate sxs of depression are ______
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Mild-moderate sxs of depression are common
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MDD occurs in __-__% of pregnant women
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MDD occurs in 10-15% of pregnant women
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__% of untreated depressed women attempt suicide
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15% of untreated depressed women attempt suicide
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Diagnosing depression during pregnancy is __________ due to sxs overlap
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Diagnosing depression during pregnancy is challenging due to sxs overlap
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what are the risk factors of depression in preggers??
she said she didn't care much for this |
Prior history of depression
Young age Marital conflict Low spousal/social support More previous children Termination of previous pregnancy Early parental bereavement Excessive ambivalence about pregnancy |
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what are the 3 risks of untreated depression??
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relapse of maternal depression
preggers, labor, delivery changes long-term outcomes for child |
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describe relapse of maternal depression
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Poor self-care
Substance Abuse Suicide Postpartum depression |
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describe "preggers, labor, delivery changes"
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Pre-eclampsia
Preterm labor Lowinfant birth weight Maternal HPA axis changes |
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describe long-term outcomes for child
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Elevated cortisol levels
Poor adaptation to stress Increased risk for anxiety, depression, and behavioral disorders Increased risk for medical problems |
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what are the risks of depression in pregnancy in the mom
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Non-compliance with prenatal care
Self-medication with drugs, alcohol, tobacco 10-12% smoke tobacco 14-15% use alcohol 3% use illicit drugs Poor bonding with baby Impact on family Self harm/suicide Post-partum depression |
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what are the risks of depression in pregnancy in the fetus
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Pre-term labor
Premature birth (<37 wks) Low birth weight Small for gestational age, small head circumference (stress state) Low APGAR scores Neonatal complications NICU admissions Fetal demise |
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describe bipolar disorder in preggers
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Impact of pregnancy isn’t well understood
Studies yield mixed results, some suggesting pregnancy may be protective (those w/ tx-responsive illness) and others not However, risk for postpartum relapse is high (70% of PP women) Elevated risk for PPP has been shown as well Pre-pregnancy psychiatric evaluation is critical |
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what is bipolar disorder
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(aka manic depression) is a diagnostic category describing a class of mood disorders in which the person experiences episodes of depression followed by mania, hypomania, and/or mixed states. Left untreated, it is a severely disabling psychiatric condition.
Bipolar Disorder is thought to be based on biological conditions in the brain which may cause the chemical imbalance in serotonin and norepinephrine levels usually attributed to depression. |
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Modest levels of anxiety are ________
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Modest levels of anxiety are common
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Large prospective study showed _____% of women were symptomatic, ___% of those with high anxiety in pregnancy had high anxiety after delivery
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Large prospective study showed 21.9% of women were symptomatic, 64% of those with high anxiety in pregnancy had high anxiety after delivery
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Antenatal anxiety predicted PPD at ____ wks & ___ mos, after controlling for AD
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Antenatal anxiety predicted PPD at 8 wks & 8 mos, after controlling for AD
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_________ HR and RR, normal to pregnancy, may contribute to anxiety and panic
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Increased HR and RR, normal to pregnancy, may contribute to anxiety and panic
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Postpartum period appears to be a time of _________ vulnerability for BOTH first onset and relapse of most anxiety disorders (PD, OCD, and PTSD)
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Postpartum period appears to be a time of increased vulnerability for BOTH first onset and relapse of most anxiety disorders (PD, OCD, and PTSD)
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describe eating disorders in preggers
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Women with anorexia may experience infertility
Trigger: weight gain of pregnancy EDs associated with greater risk of fetal complications, C-section, and postpartum depression Patients should be counseled to avoid conception until symptoms abate Therapy before, during, after to help reduce distress related to changing body shape |
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what is the biggest predictor in PPD
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MDD
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Many women with pre-existing psychiatric disorders choose to ____________ psychotropic medications in pregnancy
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Many women with pre-existing psychiatric disorders choose to discontinue psychotropic medications in pregnancy
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of those with depressive relapse, ____% relapsed when discontinued meds, ___% relapsed with continued med use
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of those with depressive relapse, 68% relapsed when discontinued meds, 28% relapsed with continued med use
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Mild symptoms of depression = ___________ interventions
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non-pharmacologic
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do we prefer non-pharma or pharmacological interventions
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non-pharma
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when should we consider meds for depression in pregger ladies. Why should we give them meds
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Medication should be considered for the treatment of disabling or serious depression, threatening maternal or fetal well-being.
Protects against post partum depression |
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what do women go through when transitioning to motherhood
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Single most significant transition in early adult life for women
Mother’s emotional imaginary world of fears, hopes, dreams, fantasies comes to life Joining of the emotional & practical (giving birth and caring for baby) Healthy coping with transition: recognize gains and necessary losses Little “room” to talk about motherhood losses |
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what do you lose when you become a mom.
This is a big ass list |
Body/ physical changes
Confidence/self-esteem Sleep Time for self/independence Work identity Control/predictability Spontaneity Intimacy and relationship focus Romantic vision of being perfect mother Special attention from pregnancy |
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what are the joys of motherhood
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The experience of tender love for one’s baby
The Feeling of pride at having created another being The Amazement of becoming both bountiful and nurturant A new level of intimate connection with one’s partner A deepened sense of personal maturity and worth |
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what kind of moms adjust best to motherhood
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Those that seem to adjust the best are open to both the positive and negative aspects
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what kinds of moms adjust poorly to motherhood
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Those that have difficulties typically have unrealistic expectations about universal physical and emotional challenges
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What are the physical and emotional challenges of motherhood
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Indescribably fatigue
Engorgement of the breasts in the first week Transient moodiness At times feeling entirely unprepared |
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what is the gerber myth
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Women generally seem entirely unrealistic about the strains of taking care of newborns
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where do we get our expectations and fantasies of motherhood
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experiences
cultural background |
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In face of discrepancy between what is anticipated and what is experienced = __________,____________,___________,________________
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guilt, confusion, unhappiness, anxiety
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Women with PPD, ___________ quantity and severity of those disappointments
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Women with PPD, increased quantity and severity of those disappointments
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______ woman with PPD has initial stages of motherhood as she’d fantasized
All or no |
No woman with PPD has initial stages of motherhood as she’d fantasized
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Are women who are depressed more likely to experience change in the form of loss rather than opportunity for growth,
or Is depression caused by the losses and disappointments perhaps related to unrealistic expectations for new motherhood? |
Both
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what is the perfect storm of ppd
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Unrealistic expectations
Hormonal changes Sleep Deprivation Single biggest identity transition for women Possible difficulties in pregnancy or birth Possible predisposition for depression or anxiety (prior depression is biggest predictor for PPD) |
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what are the three Psychological disturbances that can occur during the postpartum period
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Postpartum blues (i.e., “baby blues”)
Postpartum depression Postpartum psychosis |
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T or F
Any psychiatric disorder may present or recur in the postpartum period |
T
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T or F Mood disorders are uncommon
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F
Mood disorders are most common |
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describe postpartum blues
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Common, benign, transitory
Mild sxs occurring in the first 10 days (begin day 3-4, peak day 4-5) 26-85% of new mothers More pronounced than normal daily fluctuations in mood Most recover within 2 weeks |
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what are the symptoms of postpartum blues
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Weeping
Emotional liability Sad mood Irritability Lack of affection Hostility towards husband Feelings of unreality |
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describe postpartum depression
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12-14% prevalence
Usually begins within 1-6 months after delivery DSM criteria:MDE occurring within 4 weeks postpartum Onset: May “grow” out of postpartum blues May have initial period of well-being following delivery |
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what are the symptoms of postpartum depression
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Tearfulness
Despondency Emotional lability Excessive guilt Excessive worry about baby’s well-being Poor concentration & memory See self as “bad,” “unloving,” “inadequate” mother |
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What is DSM-IV criteria for postpartum depression
not into this slide she said |
Depressed Mood
Anhedonia Appetite and/or weight changes Sleep Problems Psychomotor changes Fatigue/low energy Excessive guilt/feelings of worthlessness Impaired concentration Suicidal ideation Onset of episode is w/in 4 weeks postpartum |
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how do depressed moms feel? *she liked this slide
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Depressed, sad, mournful
Anxious, Panic Feelings of unreality, “Numb” Resentful Irritable or angry Regretful, “What have I done?” Hopeless Lonely Feelings of Loss, Missing “old life” |
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How do depressed new moms think
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Unrealistic expectations new motherhood
Unrealistic expectations for baby Preoccupation with baby’s safety & vulnerability Negative thinking/thought distortions Suicidal ideation Egodystonic thoughts of harming baby (thoughts that cause distress or internal conflict because they occur in the context of wanting to keep their baby safe) |
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How do depressed new moms DO
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Avoid sex and/or physical affection at all costs
Conflict or strain with spouse Diminished or absent bond with baby Near frantic efforts to gain control Frequent calls/visits to Pediatrician Seeking expert advice/reading baby advice books “Sleep training” too early Sleep Problems Can’t sleep when baby sleeps Can’t get out of bed Breastfeeding difficulties |
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Risk factors for PPD
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History of mood disturbance before or during pregnancy *
Lower family income Lower occupational status Poor marital relationship Low social support Coexistence of excessive life stress |
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what are treatment considerations for PPD
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Etiology of PPD remains unclear
Treatments address both biologic and psychosocial factors Extensive literature examining the treatment of PPD Pharmacologic treatment SSRIs most widely studied (esp. Fluoxetine) Depending on SSRI, could be problematic for women who are breast feeding, story is still unfolding Strong evidence of effectiveness for psychosocial interventions |
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describe postpartum psychosis
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Rare, 2 in 1000
First month is time of elevated risk (10-20X) Most begin w/in first 3 weeks Usually asymptomatic for 2-3 days postpartum Most common presentation is affective disorder |
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what are the symptoms of postpartum psychosis
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Impairment in reality testing
Delusions Hallucinations Tearfulness Psychomotor retardation Excessive guilt/worthlessness Sleep & appetite disturbances |
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what are the risk factors for postpartum psychosis
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Best predictor of developing PPP is a prior history of mood or psychotic disorders
Women with history of Bipolar Disorder = 50% chance of developing postpartum psychosis First degree relatives of those with BPD are also at increased risk Women with history of Schizophrenia = 24% chance of developing postpartum psychosis |
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what are treatment approaches for postpartum psychosis
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hospital admission- psych emergency
pharm or psychosocial interventions |
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describe pharm treatments
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Antidepressants
Mood stabilizers Antipsychotic Agents |
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describe psychosocial interventions
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Education about child care
Cognitive-behavioral therapy Marital therapy |
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___% of adequately treated women improve within 2-3 months
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95% of adequately treated women improve within 2-3 months
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What are barriers to seeking therapy
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Sign of weakness
Financial commitment/practical concerns Fear of being labeled Mismanaged priorities Denial Generalizing past negative experiences Lack of support |
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what are pharmacological treatment interventions that psychologists use
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Elimination of caffeine, nicotine, & alcohol
Adequate sleep Facilitating communication physician Reduction of psychosocial stress Relaxation techniques Light therapy Psychosocial Treatments |
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what are some psychosocial treatments
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Support groups
Couples therapy Cognitive-Behavioral Therapy (CBT) Interpersonal Therapy (IPT) |
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what are therapeutic benefits to education??
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Normalizes responses to transition -feelings, thoughts, &behaviors
Promotes self acceptance Fosters formation of realistic expectations May be pathway by which women experience motherhood as positive evolution of self May prevent development of distress and psychiatric symptoms |
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describe interpersonal psychotherapy
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is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on interpersonal processes rather than intrapsychic processes. IPT aims to change the person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations.
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describe Cognitive behavioral therapy
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an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state.
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what are common therapy goals from PPD??
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Healing from unrealized fantasies
Recognition, acceptance, and grieving of real losses Developing a strong network of support Addressing intergenerational issues (“Will I be just like my mother?” Promote development of relationship with newborn Recognize stressors and their impact on the ways one thinks, feels, and behaves Identify irrational/negative beliefs and thought patterns and replace them with more realistic views: Developing health coping strategies (e.g., limit setting, assertiveness) Recognizing the importance of self-care behavior |
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Do depressed moms neglect their own care? if do give examples
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Yes
Showering Eating meals Making time for oneself |
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do psychosocial treatments work??
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Ample support for benefits of pharmacologic and psychotherapeutic treatments
Women prefer psychosocial treatments One study's meta-analysis treatment showed that overall, TXs had a large effect on depression in women with PPD |
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How do men feel when their baby momma is pregnant?
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Surge of happiness, validation of masculinity
Envy towards prospective mother Concerns of responsibility, adulthood, aging Competition or/and need for connection with own father Jealousy of developing fetus Unresolved conflicts in marriage “Engrossment” |
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Can men become PPD?
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Yes
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Describe how PPD men feel
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Confusion, anger, resentment
Common behavioral reactions: Pretending it isn’t happening Criticizing or judging her Blaming her or someone else for PPD Smothering her or overreacting Becoming overly preoccupied with what and why she is feeling a certain way instead of accepting feelings Support wife’s decision to seek help Therapy may be necessary for husbands |